Factors associated with late diagnosis and delayed presentation of Hiv/aids patients at the Kenyatta Hospital Comprehensive Care Centre

Abstract

Introduction Ensuring timely access to care for persons with HIV is an important public health goal. This study aimed to identify factors associated with late HIV diagnosis and delayed presentation to medical care after testing Hiv-positive, Objectives To determine the association between the demographic, socio-economic & behavioral factors with late HIV testing and delayed presentation to care at KNH CCC Methods A cross-sectional survey was carried out. Two hundred and nineteen patients with Hiv infection were consecutively recruited from the Comprehensive Care Centre at the Kenyatta National Hospital. Patients diagnosed with HIV infection presenting for the first time were recruited and an interviewer-administered questionnaire was used to collect information about participants' demographic, socio-economic, behavioral and clinical data. Thereafter, a detailed physical examination was conducted with confirmatory laboratory tests as necessary and participants staged according to WHO Staging System. "Late diagnosis" was defined as patients with a CD4 count <200 /mm3 or World Health Organization Clinical Stage 3 and 4 disease at enrollment while "Delayed presention" was when 3 months had elapsed between the date of their first HlV-positive test and their presentation for HIV care. Results Two hundred and nineteen subjects were interviewed. The mean age was 35 years and there were 137 (63%) females. Fifty seven percent were married. Among the 219 study subjects, 107 (49%) were defined as late testers while 23 (10%) were defined as delayed presenters. Subjects who tested for health related reasons were more likely to be diagnosed late [OR=3.284 (1.71-6.33), p=0.0000]. Persons indicating "fear for stigma" as a barrier were almost 3 times less likely to delay presentation after testing Hiv- positive [OR=0.36(0.14-0.95), p=O.033]. There was no association between patients' demographic, socio-economic and behavioral characteristics such as age, sex, marital status, level of education, residence, home ownership, sexual contacts, number of sex partners and perception of risk with either late diagnosis or delayed presentation to care. Conclusion Late diagnosis of Hiv infection is a significant problem. Diagnosis usually occurs in the course of medical care, often during care for complications of HIV. Improved HIV testing strategies may allow for more timely diagnosis of HIV infection, which may benefit both the infected individual and society.